Concepts and Mechanisms of Migraine Chronification

Authors

  • Marcelo E. Bigal MD, PhD,

    1. From the Departments of Neurology, Albert Einstein College of Medicine and The Montefiore Headache Center, Bronx, NY, USA (Bigal); Departments of Neurology and Epidemiology and Population Health, Albert Einstein College of Medicine, and The Montefiore Headache Center, Bronx, NY, USA (Lipton).
    Search for more papers by this author
  • Richard B. Lipton MD

    1. From the Departments of Neurology, Albert Einstein College of Medicine and The Montefiore Headache Center, Bronx, NY, USA (Bigal); Departments of Neurology and Epidemiology and Population Health, Albert Einstein College of Medicine, and The Montefiore Headache Center, Bronx, NY, USA (Lipton).
    Search for more papers by this author

  • Conflict of Interest: None

Marcelo E. Bigal, Department of Neurology, Albert Einstein College of Medicine, 1165 Morris Park Avenue, Bronx, NY, USA.

Abstract

Migraine is a chronic recurrent disorder with episodic manifestations that is progressive in some individuals. Migraine progresses clinically, physiologically, and anatomically. Progression may be a consequence of the mechanisms that generate the migraine attacks (eg, cortical spreading depression) or it may be a function of the activations generated by the attacks (eg, lesions in the periaqueductal gray area), a hypothesis supported by the increase in lesions with attack frequency. Progression may also be partially explained by common genetic or environmental risk factors. Finally, migraine with aura is associated with an elevated Framingham score and with risk factors for cardiovascular disease. Research on this issue is in its infancy and cautions are necessary before extrapolating this information into clinical practice.

Ancillary